Organization
SOUTHWEST SURGERY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARRIE L. RIESDORPH (OFFICE MANAGER)
(928) 854-6500
Entity
Organization
Contact information
Practice address
1810 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5886
(928) 854-6500
(928) 854-6206
Mailing address
1810 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5886
(928) 854-6500
(928) 854-6206
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
31136
AZ
Other
Enumeration date
10/27/2006
Last updated
08/22/2020
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